Physiological Factors Linking Insecure Attachment to Psychopathology: A Systematic Review
Abstract
:1. Introduction
1.1. Physiological Factors Linking Attachment and Psychopathology
1.2. Physiological Factors as Emotion Regulation Index
1.3. Which Physiological Factors of Emotions Are Involved in Research?
2. Methods
- Selection of our topic of interest (identifying the physiological factors underlying the relationship between attachment and psychopathology and how these work);
- Literature search and screening of results;
- Summary of results and discussion;
- Conclusions.
2.1. Data Collection
2.2. Selection Criteria and Eligibility
2.3. Quality Assessment
3. Results
3.1. Main Characteristics of Studies Included
3.2. Main Results
3.2.1. Group 1: Respiratory Sinus Arrhythmia (RSA; n = 4 Studies)
3.2.2. Group 2: Skin Conductance Level Variability (SCLV; n = 1 Study)
3.2.3. Group 3: Cardiac Slowing (CS; n = 1 Study)
4. Discussion
4.1. Risk of Bias in Included Studies
4.2. Future Research Agenda in Light of Limitations
4.2.1. Clinical Samples and Psychopathology
4.2.2. Valid and Reliable Methods to Detect Physiology
4.2.3. Methodological Improvements (Sample and Statistical Analysis)
4.2.4. Diathesis-Stress vs. Differential Susceptibility
4.3. Clinical Implications
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
SWiM Is Intended to Complement and Be Used as an Extension to PRISMA | |||
SWiM Reporting Item | Item Description | Page in Manuscript Where Item Is Reported | Other |
Methods | |||
1 Grouping studies for synthesis | (1a) Provide a description of, and rationale for, the groups used in the synthesis (e.g., groupings of populations, interventions, outcomes, study design) | 6 | |
(1b) Detail and provide rationale for any changes made subsequent to the protocol in the groups used in the synthesis | / | ||
2 Describe the standardized metric and transformation methods used | Describe the standardized metric for each outcome. Explain why the metric(s) was chosen, and describe any methods used to transform the intervention effects, as reported in the study, to the standardized metric, citing any methodological guidance consulted | 4–5 | |
3 Describe the synthesis methods | Describe and justify the methods used to synthesize the effects for each outcome when it was not possible to undertake a meta-analysis of effect estimates | 9–11 | |
4 Criteria used to prioritize results for summary and synthesis | Where applicable, provide the criteria used, with supporting justification, to select the particular studies, or a particular study, for the main synthesis or to draw conclusions from the synthesis (e.g., based on study design, risk of bias assessments, directness in relation to the review question) | 11 | |
5 Investigation of heterogeneity in reported effects | State the method(s) used to examine heterogeneity in reported effects when it was not possible to undertake a meta-analysis of effect estimates and its extensions to investigate heterogeneity | / | |
6 Certainty of evidence | Describe the methods used to assess certainty of the synthesis findings | / | |
7 Data presentation methods | Describe the graphical and tabular methods used to present the effects (e.g., tables, forest plots, harvest plots).Specify key study characteristics (e.g., study design, risk of bias) used to order the studies, in the text and any tables or graphs, clearly referencing the studies included | 6–7 | |
Results | |||
8 Reporting results | For each comparison and outcome, provide a description of the synthesized findings, and the certainty of the findings. Describe the result in language that is consistent with the question the synthesis addresses, and indicate which studies contribute to the synthesis | 11 | |
Discussion | |||
9 Limitations of the synthesis | Report the limitations of the synthesis methods used and/or the groupings used in the synthesis, and how these affect the conclusions that can be drawn in relation to the original review question | 13–15 |
Appendix B
Items | Yes | No |
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Construct | Filter (Key Terms) |
---|---|
Physiological parameters | “SCL variability” OR “SCLV” OR “respiratory sinus arrhythmia” OR “RSA” OR “vagal tone” OR “cardiac slowing” OR “HRV” OR “heart rate variability” OR “SCL” OR “skin conductance level” OR “physiological measures” OR “physiological regulation” OR “physiological” OR “cardiac vagal tone” OR “cardiac vagal responses” |
Attachment | “attachment theory” OR attachment OR “attachment style” OR “Insecure attachment” OR “Disorganized attachment” OR “Attachment model” OR “Attachment representations” OR “Internal working model” OR “IWM” |
Psychopathology | “mental illness” OR “mental health” OR “mental disorder” OR “psychiatric disorder” OR disease OR symptom OR psychopathology OR problem OR disorder OR DSM OR ICD OR psychiatric |
Mediation/ moderation analysis | mediation OR mediator OR mediating OR moderator OR moderating OR moderation OR “SEM” OR “structural equation modelling” OR “structural equation modelling” OR “(Baron and Kenny)” OR “indirect effect” |
Inclusion Criteria | |
---|---|
Population | All stages of human development (from early childhood to older adulthood), taken individually or as a dyad (mother-child or as a romantic couple) |
Intervention/ exposure | The presence of physiological processes as a mediator/moderator variable within the link between attachment (Independent variable) and different aspects of psychopathology (Dependent variable) such as disorders (e.g., specific DSM diagnosis), psychopathological indicators (e.g., anxiety/depression symptoms), and behavioural/psychological dysfunctions (e.g., emotional dysregulation, negative affectivity, peer-problems) consistent with theoretical evidence explored in the Introduction section |
Comparisons | Control groups, same sample evaluated over time, differences between groups |
Outcomes |
|
Setting | Any settings |
Study design | Any study design (i.e., longitudinal or cross-sectional) |
Limits | English and Italian language only; no temporal limits; only peer-reviewed studies |
Exclusion Criteria | Attachment as moderator or mediator, positive outcomes (e.g., prosocial behaviour), no reference to disorders, or psychopathological indicators or behavioural/psychological dysfunctions, no measures of attachment, no physiological measurements, no empirical research, no peer-reviewed studies |
Author/s | Aim Clear | Design Appropriate to Aim | Sample Representative | Psychometric Characteristics | Acceptable Methods of Data Analysis | Significance of X on Mediator and of Mediator on Y | Interaction Test in Moderation | Clear Findings | Control Confounding Factors | Final Rating |
---|---|---|---|---|---|---|---|---|---|---|
Diamond et al. [68] | 1 | 1 | 0 | 1 | 1 | 1 | NA | 1 | 1 | 7 |
Fagundes et al. [88] | 1 | 1 | 1 | 1 | 1 | NA | 1 | 1 | 0 | 7 |
Conradt et al. [89] | 1 | 1 | 1 | 1 | 1 | NA | 1 | 1 | 1 | 8 |
Sbarra et al. [90] | 1 | 1 | 1 | 1 | 1 | NA | 1 | 1 | 1 | 8 |
Bosmans et al. [91] | 1 | 1 | 1 | 1 | 1 | NA | 1 | 1 | 1 | 8 |
Murdock et al. [92] | 1 | 1 | 0 | 1 | 1 | 1 | NA | 1 | 1 | 7 |
White et al. [93] | 1 | 1 | 1 | 1 | 1 | 1 | NA | 1 | 1 | 8 |
Author/s (Year) Country | Sample | Design and Mediation/Moderation Analysis | Attachment Measures | Attachment Type and Attachment Figure | Physiological Measures | Outcome Measures | Statistical Findings | Quality Assessment Scale |
---|---|---|---|---|---|---|---|---|
Diamond et al. [68] US | 75 young men (Mage = 21.69, SD = 3.47; 0% female) | CS; Baron & Kenny steps, Sobel test | ECR [94]; WHOTO [95,96] | Secure/Insecure; Current relationship | Baseline RSA (ECG plus latex rubber pneumatic bellows girth a sensor fitted around the participant’s chest) | Anger recovery (baseline minus post-task difference scores in RSA) | Adults with higher perception of security in their attachment relationships had more effective anger recovery and baseline RSA mediated this association (β = 0.18, p < 0.05; ΔR2 = 0.04, p < 0.10) | moderate |
Fagundes et al. [88] US | 110 teenagers at age 14 (50.9% female) and at age 18 (N = 71) | LO; Multiple linear regression | AAS-R [97] | Avoidance; Mother | RSA (ECG plus latex rubber pneumatic bellows girth sensor) | Modified versions of items from ETIG [98] | The interaction term between attachment avoidance and stress-induced changes in RSA is significant (β = −0.60, p < 0.001)Association between attachment avoidance and poor current adjustment to loss was positive for those with fewer stress-induced changes in RSA (t = 3.17, p < 0.001, r2 = 0.12), whereas this association was negative for those with higher levels of stress-induced changes in RSA (t = −3.66, p < 0.001, r2 = 0.16) | moderate |
* Conradt et al. [89] US | 73 infants, age 5 months (Mage = 20.99 weeks, SD = 2.55; 55.8% female) and age 17 months (Mage = 17.6 months, SD = 1.76; 55.8% female) | LO; Hierarchical regression analysis | SSP [99] | Secure/insecure; Mother | Baseline RSA (bioamplifier) | BITSEA [100] | The interaction term between attachment relationship and baseline RSA is significant (β = 0.36, p = 0.01; ΔR2 = 0.09, p < 0.10). Specifically, there is a significant difference in problem behaviour depending on attachment classification only in infants with high baseline RSA (b = 7.25, p = 0.02; Disorganized: M = 31.25, SD = 16.68; Secure: M = 14.83, SD = 5.85) | strong |
* Sbarra et al. [90] US | 89 adults (Mage = 40.1, SD = 9.75; 65.2% female) | CS; Hierarchical regression analysis | ECR-R [101] | Avoidance; Close relationship | RSA (ECG plus respiratory effort transducer) | LOS; ROS [102] | Highly avoidant adults during the DMAT who had increase in RSA showed improvements in the self-concept reorganization three months later (t = 2.07, p = 0.03, r2 = 0.05), while highly avoidant adults who had a decrease in RSA showed relatively little self-concept reorganization (t = −2.10, p = 0.04, r2 = 0.05). The interaction term was significant (β = −0.19, p = 0.05; ΔR2 = 0.02) explaining 2% variability in the outcome variable | strong |
Bosmans et al. [91] Belgium | 60 children (Mage = 10.45, SD = 1.06; 50% female) | CS; Hierarchical multiple regression analysis | ECR-R children version [103] | Anxiety; Mother | SCL variability (electrodes on fingers in nondominant hand) | CES-D short form [104,105] | The interaction term between attachment anxiety and SCLV was significant (β = 0.39, p < 0.01; ΔR2 = 0.14, p < 0.01), suggesting that among children with higher SCLV there was a positive association between attachment anxiety and depressive symptoms (only in 34% of the children), but among those with low SCLV the association is negative | strong |
Murdock [92] US | 213 adults | CS; SEM Bootstrapping | ECR-SF [106] | Avoidance; Close relationship | Baseline RSA (ECG and respiratory band) | PSS [107] | Adult attachment avoidance was indirectly associated with self-reported health via general stress (β = −0.019, p < 0.05), but only among those with high stress-induced RSA (in 75.59% of the study sample) and not in adults with low stress induced RSA, demonstrating significant interaction between attachment avoidance and stress induced RSA (β = 0.17, p < 0.05) | strong |
White et al. [93] Germany | 165 children, school-age (Mage = 8.42, SD = 2.7 months; 46.1% female) of which 139 infants, preschoolers (Mage =5.19, SD = 5.9 months) | LO; SEM Bootstrapping | MSSB [108] | Positive and negative representations; Parents | C-S | SDQ—Peer Problems subscale; [109] | Positive representations at pre-school age predicted fewer peer problems at school age, through the path (β = 0.29, p < 0.01) from cardiac deceleration to peer problems (indirect effect: 95% CI [−1.416, −0.011]) | strong |
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Tironi, M.; Charpentier Mora, S.; Cavanna, D.; Borelli, J.L.; Bizzi, F. Physiological Factors Linking Insecure Attachment to Psychopathology: A Systematic Review. Brain Sci. 2021, 11, 1477. https://doi.org/10.3390/brainsci11111477
Tironi M, Charpentier Mora S, Cavanna D, Borelli JL, Bizzi F. Physiological Factors Linking Insecure Attachment to Psychopathology: A Systematic Review. Brain Sciences. 2021; 11(11):1477. https://doi.org/10.3390/brainsci11111477
Chicago/Turabian StyleTironi, Marta, Simone Charpentier Mora, Donatella Cavanna, Jessica L. Borelli, and Fabiola Bizzi. 2021. "Physiological Factors Linking Insecure Attachment to Psychopathology: A Systematic Review" Brain Sciences 11, no. 11: 1477. https://doi.org/10.3390/brainsci11111477